Survey

Survey on the Medical Use of Cannabis and THC in Germany

AuthorF. Grotenhermen, M. Schnelle

AbstractIn recent years, a number of open patient interviews and standardized surveys have been conducted to gain more information concerning subjective experiences with the use of cannabis products in a multitude of medical conditions. After a first effort in 1999 (Schnelle et al. 1999), a second anonymous survey was conducted among patients in the German speech area of Europe concerning use of natural illegal cannabis products and THC, a natural cannabinoid that may be prescribed by German doctors since 1998, and that is also manufactured synthetically.

Questionnaires were distributed to the members of the Association for Cannabis as Medicine (ACM) and additional persons interested in participating. One hundred eighty-two completed questionnaires were sent to the Institute for Oncological and Immunological Research and the ACM, of whom 17 were excluded because these participants apparently did not suffer from severe diseases. Of the 165 respondents included in the final analysis, 61.2% were male and 38.8% were female. Median age was 40.3 12.4 years, with a range of 16 to 87 years.

Twenty-two participants did not use cannabis products for therapeutic purposes. The main reasons were fear of criminal prosecution, the assumption that their doctor will not prescribe THC or a refusal of the doctor to do so.

Among the 143 participants with cannabis or THC experience, the main diagnosis groups were neurological symptoms (28%) and painful conditions (25.3%), followed by diseases with mainly gastrointestinal symptoms, such as nausea and appetite loss (14%). The most frequent single diagnoses were multiple sclerosis (17.5%), Tourette syndrome (11.9%), HIV/AIDS (10.5%), migraine/headache (4.9%), chronic pain that was not described more precisely (4.2%), hepatitis C (3.5%), depression, sleep disorders, spinal cord injury, and back pain (2.8%, each), asthma, allergy, fibromyalgia, menstrual pain, and epilepsy (2.1%, each).

Average daily THC doses were 14.9 9.5 mg, ranging from 4 to 35 mg. Doses of natural cannabis products (marijuana, hashish) were 1.3 0.9 grams on average (range: 0.02-3.5 g). The drugs were inhaled by 55.9%, employed orally by 16.8%, and 23.1% used both routes of administration.

The cited conditions were much improved by cannabis or THC in 74.8%. An additional 13.3% of patients noted a small improvement, and 2.1% noted no improvement. Others were unsure whether it improved their condition (7.0%), or did not answer this question (2.8%). High satisfaction was reported in 54.5%, 28.0% were satisfied, 14.0% were partly satisfied and 2.1% were not satisfied, while 1.4% did not answer. No side effects were experienced in 73.4%, while 22.4% reported moderate side effects, and 4.2% did not respond. About three-quarters made statements to the consequences of discontinuation of use with regard to withdrawal symptoms. Of these, 67.6% reported no withdrawal symptoms; in 17.6% these symptoms were mild, and in 2.8% they were more severe, while 12.0% reported that they could not evaluate the severity of withdrawal symptoms.

Fifty-three participants noted that they had asked their doctor to prescribe THC. In 54.8% the doctor was willing to do so, but in more than half of the cases (54.9%), the health insurance companies refused to pay for the treatment. There was no association between the reaction of the doctor or of the health insurance and the diagnosis. Most of the participants who reported a refusal by their doctor or the health insurance used illegal cannabis products in the previous month.

Experience with both the medical use of THC and natural cannabis products was reported by 16 participants. There were no clear differences between both drugs with regard to side effects and medicinal efficacy. In conclusion, this survey adds to an increasing number of patient reports of successful and well-tolerated medical uses of cannabis products in a multitude of conditions. Furthermore, it reflects the division of German doctors and health insurances on the issue.